Kazakhstan’s Legacy of Public Health

Kazakhstan faces a historical legacy of promoting the healthcare and well being of their citizens beyond the emergency room. In fact, the first international declaration of the importance of primary care was made in Almaty, Kazakhstan. The 1978 “Declaration of Alma-Ata” was instrumental in the development of a variety of contemporary organizations and initiatives, from the World Health Organization to the UN’s Millenium Development Goals. From Wikipedia:

(The Declaration of Alma-Ata) expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of the World Health Organization (WHO) as the key to achieving the goal of “Health for All”

Importantly, the the 1978 declaration of Alma-Ata reaffirmed that health is “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.” Public health seeks to actively promote the well being of a nation or region’s citizens. Evidence and experience suggest that this is an improvement over traditional disease oriented systems. Dr. Margaret Chan, Director General of the World Health Organization, speaking in a converence on rural health care, defined Public Health thus:

“First, the highest duty of public health is to protect populations from risks and dangers to health. This duty belongs to government. It includes the performance of basic public health functions, such as ensuring the quality of medicines and the safety of the food, water, and blood supplies.

It also includes a responsibility to ensure that populations have the information and the means to protect their health. Obviously, it includes regulatory functions and requires the investment of public funds.

Second, the highest ethical principle of public health is equity. This can be expressed in simple terms. People should not be denied access to life-saving or health-promoting interventions for unfair reasons, including those with economic or social causes.

Third, the greatest power of public health is prevention. Medicine focuses on the patient, but public health seeks to address the causes of ill health in ways that provide population-wide protection.

All of these principles are embodied in the primary health care approach.

Within the speech, which I’ll link to at the end, Dr. Chan also identifies the broad economic gains that nations are able to achieve by adopting the primary care/public health approach. First I’ll mention the savings. Widely available primary care enables citizens to address illness before it becomes a more serious (read: expensive) problem. The savings to a health system in the category can be enormous. Second comes the health of a worker. Dr. Chan, quoting a doctor in Argentina working on micro financing schemes for women, had this to say:

“The human body is a unique tool for productivity that even the poor possess.”

Healthy workers mean less sick days and a more productive populace. A third benefit is for entrepreneurship and worker mobility. Adequate public health safety nets mean the ability to risk starting a new business, or the safety of moving to a better job. In the aggregate, this means more a more efficient economy. The third point is particularly important in Kazakhstan. The population migration of the last decade have meant a shift to the urban centers of Almaty and Astana and the oil fields of the west. However, as my fellow fellow Emin Hasanov has pointed out, Kazakhstan holds an incredible abundance of natural resources all over the country. In her 2002 book “Kazakhstan: Unfulfilled Promise,” Martha Brill Orkut noted that population shifts have meant:

“…a shortage of qualified workers in East Kazakhstan, West Kazakhstan, North Kazakhstan, Karaganda and Kostanai oblasts. If the pace of investment were ever to pick up dramatically, this shortage could create severe problems for the country.”

Public health in general, and mobile health in particular, represent not a drain on valuable resources, but a potential boon for quickly developing Kazakhstan. Although the 1978 Declaration of Alma-Ata was made when Kazakhstan was still a Soviet republic, the spirit of the declaration and its location should serve a galvinizing force in Kazkahstan’s public health efforts. More to follow soon!

Dr. Chan’s Speech


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